Osteoporosis Flashcards
Risk factors for osteoporosis
Increasing age
Parental history of hip or spine fracture
BMI less than 20
Smoking
Excessive alcohol consumption
Drugs including: Antiepileptics, antiretrovirals, glucocorticoids, heparin, aromatase inhibitor‘s, Depo, GnRH agonists and antagonists
What is a T-score
Normal
Osteopenia
Osteoporosis
The number of standard deviation‘s above or below mean bone mineral density for healthy young adults
- 1.0 or greater
- 1.0 to -2.5
- 2.5 or less
What is a Z score
What’s abnormal
Number of standard deviations from individuals bone mineral density compared to those of the same sex, age, ethnicity
Less than -2.0
What are the diagnostic criteria for osteoporosis
T-score -2.5 or less
Fragility fracture
T score -1 to -2.5 and increased fracture risk (FRAX)
10 year probability hip fx greater than or equal to 3%
10 year major osteoporotic fracture greater than or equal to 20%
When should repeat bone mineral density screening be performed?
In 4 to 8 years after a normal DEXA
Two years in patients with bone mineral density near treatment threshold
One year for patients at risk of short term decrease in bone mineral density Such as those taking glucocorticoids
What are the components of FRAX
Age Paint Weight Prior fragility fracture Parental history of hip fracture Current tobacco user Long-term use of oral corticosteroids Rheumatoid arthritis Excessive alcohol intake
What’s score on FRAX is necessary to initiate treatment
20% 10 year risk for major osteoporotic fracture
3% risk of hip fracture
**FRAX only valid for women >40
When should post menopausal women younger than 65 receive DEXA scan
Those at increased risk of osteoporosis, an 8.4% 10 year risk of major osteoporotic fracture on FRAX should be tested
Denosumab
Monoclonal antibody against receptor activator of nuclear factor kB ligand, decreases differentiation of osteoclasts
Discontinuation of linked to severe rebound vertebral fractures
After Discontinuation, alternate antiresorptive treatment should be started immediately
Parathyroid hormone related therapies
Teraparatide
Abaloparatide
Anabolic agent that leads to bone formation
Side effects include nausea, tachycardia, hypercalcemia
Use is limited to two years Due to those dependent increased risk of osteosarcoma
Romosozumab
Monoclonal antibody against sclerostin
Enhances bone formation and inhibits bone resorption
Adverse effects include hypersensitivity reaction and osteonecrosis of the jaw and atypical femoral fractures
Increased risk of cardiovascular events
Which measurements is fracture risk based on
Lumbar spine and hip bone mineral density
Bisphosphonates
Alendronate
Risendronate
Antiresorptive
AE: Gastric upset, atypical femoral fracture’s, osteonecrosis of the jaw
raloxifene
SERM
AE: VTE AND vasomotor sxs
Endocrine society’s treatment recommendations for osteoporosis
Moderate risk
Treat with bisphosphonate and reassess five years after oral or three years after IV bisphosphonate
Treatment recommendations for high-risk
Bisphosphonate or denosumab for 5-10 yrs
Estrogen therapy or sermon can be considered as an alternative if patient younger than 60 and less than 10 years past menopause
Treatment recommendations very high risk
Treat with anabolic agent for 2 yrs teraperatide, followed by 1 year romosozumab then anti-resorptive therapy
RDA recommendations for calcium and vitamin D
Calcium <50 1000 mg daily
>50 1200 mg daily
D age 70 or less 600 IU
>70 800 IU
Supplements have no effect on fracture risk and are not recommended for women that don’t have osteoporosis or D deficiency
Contraindication to bisphosphonate
Renal dysfunction
Esophageal disorder
